Diabetes Prevention Program
California state law requires the Department of Health Care Services (DHCS) to establish the Diabetes Prevention Program (DPP) as a Medi-Cal covered benefit. Medi-Cal's DPP benefit will be consistent with the federal Centers for Disease Control and Prevention's (CDC's) guidelines and will also incorporate many components of the Centers for Medicare & Medicaid Services' (CMS') DPP in Medicare.
The DPP is an evidence-based, lifestyle change program designed to assist Medi-Cal beneficiaries diagnosed with prediabetes in preventing or delaying the onset of type 2 diabetes. Medi-Cal providers choosing to offer DPP services must comply with CDC guidance and obtain CDC recognition in connection with the National Diabetes Prevention Recognition Program (DPRP). DPP services will be provided through trained peer coaches who use a CDC-approved curriculum.
Medi-Cal's DPP will include a core benefit consisting of at least 22 peer-coaching sessions over 12 months, which will be provided regardless of weight loss. In addition, beneficiaries who achieve and maintain a required minimum weight loss of 5 percent from the first core session will also be eligible to receive ongoing maintenance sessions, after the 12-month core services period, to help them continue healthy lifestyle behaviors. The CDC's DPP curriculum promotes realistic lifestyle changes, emphasizing weight loss through exercise, healthy eating and behavior modification.
- On September 28, 2021, DHCS held a stakeholder meeting to discuss changes to the regulatory bulletin entitled, "Updated Medi-Cal Enrollment Requirements and Procedures for Diabetes Prevention Programs."
- Beginning February 4, 2022, pharmacies that submit an application for enrollment can report providing DPP services in their primary application, and currently enrolled pharmacies can report providing these services by submitting a supplemental change form. The application for enrollment and supplemental change form must be submitted through the PAVE Portal.
- Additionally, in accordance with the Centers for Medicare & Medicaid Services' Calendar Year 2022 Physician Fee Schedule Final Rule, DPP providers are no longer considered institutional providers. Therefore, all applications received on or after January 1, 2022, will no longer require an application fee.
The following are state-generated resources and reference materials for beneficiaries and providers regarding Medi-Cal's DPP benefit:
The following are federally generated DPP resources and reference materials for beneficiaries and providers: